England has become the first country in the world to launch a vaccination program against gonorrhoea, as infection rates reach unprecedented levels. The initiative, set to begin in August 2024, will primarily target gay and bisexual men with multiple sexual partners or a history of sexually transmitted infections (STIs).
The announcement comes as gonorrhoea cases in England soared to more than 85,000 in 2023 – the highest number since record-keeping began in 1918. This represents a significant public health challenge, particularly as antibiotic-resistant strains continue to emerge.
Vaccine Effectiveness and Implementation
The vaccine being deployed is not specifically designed for gonorrhoea but is the meningitis B vaccine (4CMenB) currently administered to infants. Scientists discovered that the bacteria causing meningitis B and gonorrhoea are closely related, with the vaccine offering approximately 30-40% protection against gonorrhoea infection.
While this efficacy rate may seem modest, Professor Andrew Pollard, chair of the Joint Committee on Vaccination and Immunisation (JCVI), emphasized that despite being only 30% effective, the vaccine is "worth having" and could have "a huge impact" on overall infection rates.
The vaccination program will be administered through sexual health services, with local authorities and NHS sexual health clinics identifying and inviting eligible patients. The cost of the vaccine is approximately £8 per dose, and modeling by Imperial College London suggests that if uptake is substantial, it could prevent 100,000 cases and save the NHS nearly £8 million over the next decade.
Dr. Amanda Doyle from NHS England described the initiative as "a huge step forward for sexual health" that will be "crucial in protecting individuals, helping to prevent the spread of infection and reduce the rising rates of antibiotic resistant strains of the bacteria."
Targeting High-Risk Populations
The vaccine will not be universally available but will focus on populations at highest risk. In the UK, those most affected by gonorrhoea include individuals aged 16-25, gay and bisexual men, and people of Black and Caribbean ancestry.
While the primary focus is on gay and bisexual men, clinicians will have discretion to offer the vaccine to other high-risk individuals using sexual health services, including sex workers. Patients will also be able to receive mpox (formerly monkeypox), HPV, and hepatitis vaccines during the same visit.
Max, a sexual health campaigner who spoke to BBC Newsbeat after being diagnosed with gonorrhoea twice within a year, expressed enthusiasm for the vaccine: "I think this is great that it's been announced. It's going to take the pressure off the clinics, it's just a big win all round."
The Growing Threat of Antibiotic Resistance
The decision to implement the vaccine program is driven not only by record infection numbers but also by increasing concerns about antibiotic resistance. Gonorrhoea has an 80-year history of evolving resistance to antibiotics, raising fears that the infection could eventually become untreatable.
Most cases are currently treated with a single dose of antibiotics, but resistance to current treatments is growing. The UK Health Security Agency has reported that cases of gonorrhoea that are either resistant or "extensively" resistant have increased in the UK over the past three years.
Minister for Public Health and Prevention Ashley Dalton highlighted the urgency of the situation: "This world-first vaccine program represents a significant breakthrough for public health, and once again our NHS is leading the way. It could not come at a more critical time - after years of neglect of public health services, we inherited gonorrhoea diagnoses at record levels, triple what they were in 2012."
Expanding Beyond England
Public Health Scotland has announced it is working on plans to launch its own program for high-risk individuals. Responses from health authorities in Wales and Northern Ireland regarding similar initiatives are pending.
Councillor David Fothergill, chairman of the Local Government Association's Community Wellbeing Board, described the vaccine rollout as potentially "a game-changer" that could "dramatically reduce transmission of gonorrhoea."
Rising STI Rates and Contributing Factors
The gonorrhoea surge is part of a broader increase in STI diagnoses across England, with approximately 400,000 new diagnoses in 2023 – an increase of almost 5% compared to the previous year.
Dr. Emma Harding-Esch from the London School of Hygiene and Tropical Medicine suggested several factors contributing to this rise, including the increased popularity of dating apps enabling people to find sexual partners more easily, changes in public sexual behavior such as recreational drug use during sex, and inconsistent condom use with multiple partners.
Gonorrhoea does not always present symptoms, but when it does, they can include pain during urination, unusual discharge, inflammation of the genitals, and in severe cases, infertility. If left untreated, the infection can lead to complications such as infections in the eyes, testicles, or prostate.
As the program prepares to launch, health officials are emphasizing that while the vaccine offers significant protection, it does not eliminate the risk of infection, and safe sex practices remain essential in preventing transmission.
